2012 Worthington Essay Prize

Second Prize: Erin Larson $1500 (Second Prize Essay, pdf)

"The Ethics of Controlling Disease"

You are a physician who serves as Director of the Centers for Disease Control and Prevention (CDC). One afternoon you get a call from a close friend, Stephanie Boyd, who was your classmate in medical school. Boyd is a colonel in the US Army and commands the United States Army Medical Research Institute of Infectious Diseases (USAMRIID).

“I need some advice,” Colonel Boyd says. “I’m calling from Fort Bloom. I can’t give you all the particulars, because some of the details are still classified, but the broad strokes of the story—what I’m about to tell you—will become public information soon.

“With the cooperation of some of his staff, a senior medical officer here intentionally exposed his patients—including military personnel and civilians—to an infectious disease. The patients had no knowledge of the infection. The medical officer, Major Pena, made no effort to treat the disease, but instead studied its symptoms, its progression, and its transmission. There are some very sick people here and there has been one death.”

“How can I help?” you ask.

“The army has contained the outbreak. We are treating the infected and we have the situation under control. Dr. Pena and his staff have been arrested and will face courts martial. Here’s the problem: I don’t know what to do with Dr. Pena’s data. There’s a lot of information here. With the exception of the glaring ethical violations, the study was conducted with rigorous clinical methodology. This is a disease we don’t know a lot about. Pena’s data could be helpful in preventing or containing a future outbreak, or in diagnosis and thus in saving lives. Which is exactly what motivated Dr. Pena to run this awful experiment in the first place. I worry that by sharing these results with the medical community, I might be justifying or validating Pena’s actions. In the end, the decision might not be up to me, but to my superiors.

“I have always valued your judgment. What I need from you is an advisory letter, offering your opinion as a healthcare and research professional. You should address the letter to me, but it should be written in language that would be comprehensible to officers in the Pentagon who have no medical background. Should this ill-gotten but valuable data be published or not?”